Provider Demographics
NPI:1902840085
Name:HEFFERNAN, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:HEFFERNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-2830
Mailing Address - Fax:603-663-1849
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2830
Practice Address - Fax:603-663-1849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204064Medicaid
NHB98157OtherHPHC
NH0107930Y0NH03OtherANTHEM BCBS
NH0107930Y0NH03OtherANTHEM BCBS
NHB98157Medicare UPIN